Consulting an ethicist is the least common way of seeking to resolve ethical dilemmas!

For our latest blog we are thinking about ethical issues in research. Here, DEPTH staff member Dr Catherine McGowan discusses some of the roadblocks to resolving ethical dilemmas in the public health field.

Ethical dilemmas are part of professional life. But how do we navigate these dilemmas successfully? How do we ensure that we are resolving dilemmas in a way that leaves us feeling as though we have taken the best possible course of action?

People regularly make difficult decisions in their daily lives and are accustomed to resolving ethical dilemmas based on personal reflection and consultation with family, friends, and colleagues. Resolving dilemmas in the workplace, for a public health professional, is different in the sense that decisions may affect the health and wellbeing of many people. For example, decisions about resource allocation – in a context in which the public need for services outweighs an agency’s capacity to deliver – can markedly reduce life expectancy in areas not receiving services. Making the best possible decision in such circumstances, one which promises the greatest common good, is often difficult. Yet recognising, understanding, and resolving ethical dilemmas is like any other technical competency. Training in public health ethics provides the basis for sound ethical decision-making, but how many public health professionals have received education or training in public health ethics? How often do public health professionals encounter ethical dilemmas? How do public health professionals approach complex moral dilemmas?

In our latest paper entitled Education, training and experience in public health ethics and law within the UK public health workforce we present the results of a survey of 562 public health practitioners in the UK. The Faculty of Public Health, the Royal Societyof Public Health (RSPH), the UK Public Health Register (UKPHR) and Public Health England disseminated a link to an online survey asking about experience, education and training in public health ethics. Nearly 40% of respondents were public health consultants or specialists; the rest were registrars, academics, directors of public health, practitioners, managers, nurses or midwives. Over half of the respondents reported encountering ethical issues on a monthly, weekly, or daily basis whilst just under a third reported that their organisation had implemented mechanisms, adopted tools, or recommended resources to facilitate consideration or resolution of ethical issues. Interestingly, when asked to indicate how they go about resolving ethical issues the majority indicated that they resolve them in discussion with colleagues or on ‘personal reflection’. That is to say: the least common way of seeking to resolve ethical dilemmas was by consulting an ethicist!

We also asked respondents how dealing with ethical issues affects them: over half questioned whether they dealt with ethical issues in the best way and a quarter reported feeling anxious about dealing with ethical issues at work. Interestingly, many respondents indicated that they enjoyed the challenge of dealing with ethical issues. Unfortunately, relatively few respondents had received training in public health ethics.

Moving forward, we believe there is a need to develop and support capacity among the public health workforce through the provision of education, training, guidance, and mentoring in public health ethics. Public health professionals should be equipped to make the best possible decisions in complex circumstances for the betterment of health, and wellbeing and equity.

Look out for our upcoming paper in the Journal of Public Health – it will be published as part of a thematic issue on public health ethics. We’ll post about it on our Twitter feed and DEPTH website, so look out for updates.

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